Scalp transplant patient a hair better than year ago
Doctors who performed first-of-its-kind surgery marvel at man’s progress
For most men in their 50s, needing a haircut is a minor inconvenience. For James Boysen, it’s a nice problem to have.
A year ago, to repair damage caused by radiation treatments for cancer two decades ago, Boysen became the first person in the world to undergo a skull and scalp transplant. Doctors at M.D. Anderson Cancer Center and Houston Methodist performed the procedure along with a kidney and pancreas transplant in a 15-hour surgery on May 22, 2015. It involved more than 60 medical professionals. Within days, his doctors marveled to see the transplanted scalp sweat and his hair grow.
“The donor was completely shaved down to the skin level,” said Dr. Jesse Selber, the M.D. Anderson reconstructive plastic surgeon who conceived of the four-in-one marathon operation. “In two to three
weeks, he had at least a quarter inch of hair. My office pictures have this progression. He’s like a Chia pet.”
Boysen has now fully recovered from the surgery and the prolonged hospital stay that so incapacitated him he had to relearn to walk. He is now back to working as a software developer in Austin, riding his mountain bike and playing his keyboards.
“It took a while,” he said last week during a follow-up visit to Houston Methodist. “But compared to what I had felt like before, I have a lot more energy.”
Now that the medical team has been assembled with expertise in transplanting tissue complete with blood vessels, nerves and bones, the doctors are interested in conducting even more complex tissue transplants, including faces, hands and abdominal walls.
“We have everything we need to go,” said Dr. Michael Klebuc, a plastic surgeon from Houston Methodist. “But I think we’re being very thoughtful in our approach. We’re looking for the right patient.” ‘Never been done’
Boysen, meanwhile, was discharged from the hospital last June but had to remain in Houston in case he experienced any problems early on. Staying at Nora’s House, a residence for transplant patients, he watched so many reruns of Law & Order, he knew how they all ended.
Three weeks after leaving the hospital, he experienced pancreatitis, an inflammation of the pancreas common after transplant. But doctors were able to treat it with medications, and by August he was able to go home. He returned monthly, and when doctors found signs of rejection in the scalp, they adjusted his medications to tamp down his immune system even further. Additional biopsies showed the rejection stopped quickly, but the rash that is a tell-tale sign of rejection lingered.
“We didn’t know what to make of it,” Selber said. “We sort of fretted about it, but we didn’t know what to do or how much to do if it got worse.”
The rash eventually resolved, but doctors realized they were breaking new ground and wouldn’t be able to predict what would happen next. Time and again, the answer to Boysen’s questions was they simply didn’t know.
The surgeons left some extra skin where they attached the scalp so they could take biopsies to check for rejection. That left the back of Boysen’s head resembling a Shar Pei, Selber said. But over time the scalp remodeled itself, shrinking to fit snugly around the skull.
“That was impressive to me,” said Dr. Osama Gaber, director of Methodist’s transplant program.
Boysen must protect his scalp against sun exposure, which could cause skin inflammation. The immunosuppressive drugs he takes to prevent rejection also increase his risk for skin cancer. That’s how his scalp and skull were damaged in the first place. Boysen had undergone a kidney and pancreas transplant in 1992. The drugs he took to prevent rejection led to a rare form of cancer affecting the smooth muscle under his scalp. He underwent radiation therapy to cure the cancer, but the immunosuppressive drugs kept the resulting head wound from healing. When his transplanted organs began to fail, he couldn’t get a new kidney and pancreas transplant until his head healed.
Doctors saw the opportunity to solve both issues in a single operation. The team waited 18 months for a compatible donor who not only matched Boysen’s skin tone and hair color, but who could provide all four components. Patients who receive multiple solid organs from the same donor have lower rates of rejection, but doctors didn’t know whether the skull and scalp grafts would affect the organ transplants, or vice versa. While more than 35 face transplants have been done worldwide, each has shown some degree of rejection. Kidney-pancreas transplants also carry a risk of rejection.
“This combination of things has never been done before,” Selber said. “We don’t know if there’s a relationship between those two, if one harbingers the other or if one is totally independent of the other.”
That’s made Boysen’s case one that transplant programs around the world will watch carefully. Transplant doctors want to know the long-term outcomes when composites of tissue with blood vessels and nerves are transplanted at the same time as solid organs.
“Nobody has those answers,” Selber said. “In Jim, there are many answers to these questions.” ‘Unique patient’
The doctors all agree that Boysen was the perfect patient for the first such transplant. He was willing to accept the risks of the procedure, and having been through a transplant before, understood better than most the difficult road that lay before him. He was willing to accept the risk as much to advance the science as for his own personal gain.
“Jim is a unique patient that way,” Gaber said.
Boysen said the entire process was easier to handle with the support of his girlfriend, Kay Mouser, who had been with him years ago through his first kidney and pancreas transplant. She had picked up so much about the transplant process and was so adept at helping with Boysen’s care, doctors and nurses thought she had medical training.
At a news conference after his surgery last year, his scar was clearly visible, a dark red line running across his forehead below closely cropped hair that declared with no uncertainly he had undergone a major procedure. Now that his scar has healed and his hair grown out, it looks more like an unfortunate sunburn.
And where does a man with a transplanted scalp go for a haircut?
He relies on a close friend, who had cut his hair back when he still had an open wound on his head.
“I’ve had some pretty not-pleasant-to-look-at wounds,” Boysen said. “Luckily, he is a deer hunter. So it didn’t bother him.”